Does iron have a place in the management of breath holding spells?

Abstract

A 2 year old child is seen in the outpatients department with a history of breath holding spells for the past three months, occurring about 3-4 times per week. These are causing her mother a great deal of concern. You consider whether or not a course of iron would reduce the frequency of these attacks. Structured clinical questionIn a 2 year old child with breath holding spells [patient], will a treatment with iron [intervention] reduce the frequency of episodes [outcome]?Search strategy and outcome Secondary searches-Cochrane, Clinical Evidence-none.Medline 1996-2001, using the OVID interface.In order to give the best care to patients and families, paediatricians need to integrate the highest quality scientific evidence with clinical expertise and the opinions of the family.1 Archimedes seeks to assist practising clinicians by providing "evidence based" answers to common questions which are not at the forefront of research but are at the core of practice. They are based on an original format from the Journal of Accident and Emergency Medicine. 2A word of warning. These best evidence topic summaries (BETs) are not systematic reviews, though they are as exhaustive as a practising clinician can produce. They make no attempt to statistically aggregate the data, nor search the grey, unpublished literature. What Archimedes offers are practical, best evidence based answers to practical, clinical questions.Each topic follows the same format. A description of the clinical setting is followed by a structured clinical question. (These aid in focusing the mind, assisting searching, 3 and gaining answers. 4) A brief report of the search used follows-this has been performed in a hierarchical way, to search for the best quality evidence to answer the question.5 A table provides a summary of the evidence and key points of the critical appraisal. For further information on critical appraisal, and the measures of effect (such as number needed to treat, NNT), books by Sackett 6 and Moyer 7 may help. A commentary is provided to pull the information together, and for accessibility, a box provides the clinical bottom lines.Readers wishing to submit their own questions-with best evidence answers-are encouraged to read the Instructions for Authors at http://www.archdischild.com. Three topics are covered in this issue of the journal. c Does iron have a place in the management of breath holding spells? c Is omeprazole helpful in the management of children with reflux oesophagitis? c Does oral sucrose reduce the pain of neonatal procedures?

Onset of Afebrile Seizure in Transient Erythroblastopenia of Childhood

“…Iron deficiency anemia (IDA) is highly associated with BHS, and therefore, an evaluation of IDA with a complete blood count and serum ferritin levels is warranted in children with BHS [6]. In these reports, oral iron treatment was effective for 50% of BHS cases without IDA.…”

Iron function and dysfunction in the brain: A pediatric neurologist's perspective

“…An association of BHS with iron-deficiency anemia has been documented, with a higher incidence of BHS in iron-deficient children and reported improvement with restoration of normal iron indices [33,34] though the practice of treating BHS with iron is not universal. Meta-analyses have concluded that iron supplementation reduces the frequency and severity of BHS, especially in children with iron deficiency anemia [35,36]. The mechanism of this association is unknown, but may relate to altered autonomic regulation or neurotransmitter metabolism [37].…”

Breath-holding spells

“…Uit een review kwam naar voren dat na ijzertherapie een vermindering van de ernst en de frequentie van BHS werd aangetoond. 13 In een onderzoek werden 91 kinderen met BHS ingesloten. 14 Bij 63 kinderen werd een ferriprieve anemie gevonden.…”